New Non-Bisphosphonate Drugs that Produce Osteonecrosis of the Jaws

Area of Science:

• Oncology
• Oral Surgery
• Pharmacology

Background:

• Osteonecrosis of the jaws (ONJ) is a serious adverse effect associated with certain cancer therapies.
• Bisphosphonates (BP) are commonly used for bone metastases, but non-bisphosphonate drugs are also implicated in ONJ.

Purpose of the Study:

• To review the literature on the association between non-bisphosphonate cancer drugs (Denosumab, Bevacizumab, Sunitinib) and osteonecrosis of the jaws (ONJ).
• To evaluate the potential synergistic effect of these drugs when used with or without bisphosphonates.

Main Methods:

• A comprehensive literature review was performed.
• Keywords included 'osteonecrosis of the jaws', 'oral bisphosphonates', 'Denosumab', 'Bevacizumab', and 'Sunitinib'.
• Articles reporting ONJ cases associated with these specific drugs were analyzed.

Main Results:

• Denosumab is linked to ONJ, particularly with triggers like dental procedures; combination with zoledronic acid may enhance this effect.
• Bevacizumab's role in ONJ is debated, especially concerning synergistic action with bisphosphonates.
• Sunitinib is a cause of ONJ, with a potential increased risk when co-administered with bisphosphonates.

Conclusions:

• Denosumab, Sunitinib, and Bevacizumab are identified as causative agents in the development of ONJ.
• Concurrent use of these non-bisphosphonate drugs with bisphosphonates may elevate the risk of ONJ beyond that of bisphosphonate therapy alone.